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Dyspareunia is painful sexual intercourse due to medical or psychological causes. The symptoms are significantly more common in women than in men. The pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain. There are numerous physical, psychological, and social/relationship causes that can contribute to pain during sexual encounters. Commonly multiple underlying causes contribute to the pain. The pain can be acquired or congenital. Symptoms of dyspareunia may also occur after menopause. Diagnosis is typically by physical examination and a medical history. Treatment is determined by the underlying causes. Many women experience relief when physical causes are identified and treated. Even when the pain can be reproduced during a physical examination, the possible role of psychological factors in either causing or maintaining the pain must be acknowledged and dealt with in treatment. Internationally, dyspareunia has been estimated to affect between 8-21% of women, at some point in their lives. == Signs and symptoms == Women who experience pain with attempted intercourse describe their pain in many ways. This reflects how many different and overlapping causes there are for dyspareunia. The location, nature, and time course of the pain help to understand potential causes and treatments. Some women describe superficial pain at the opening of the vagina or surface of the genitalia when penetration is initiated. Other women feel deeper pain in the vault of the vagina or deep within the pelvis upon deeper penetration. Some women feel pain in more than one of these places. Determining whether the pain is more superficial or deep is important in understanding what may be causing a woman's pain. Some women have always experienced pain with intercourse from their very first attempt. Other women begin to feel pain with intercourse after an injury or infection or cyclically with menstruation. Sometimes the pain increases over time. When pain occurs, the woman may be distracted from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease. When the vagina is dry and undilated, penetration is more painful. Fear of being in pain can make the discomfort worse. Even after the original source of pain has disappeared, a woman may feel pain simply because she expects pain. Fear, avoidance, and psychologic distress around attempting intercourse can become large parts of a woman's experience of dyspareunia. Physical examination of the vulva (external genitalia) may reveal clear reasons for pain including lesions, thin skin, ulcerations or discharge associated with vulvovaginal infections or vaginal atrophy. An internal pelvic exam may also reveal physical reasons for pain including lesions on the cervix or anatomic variation. When there are no visible findings on vulvar exam that would suggest a cause for superficial dyspareunia, a cotton-swab test may be performed. This is a test to assess for localized provoked vulvodynia.〔 A cotton tip applicator is applied at several points around the opening of the vagina and a woman reports whether she experiences pain on a scale from 0-10. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「dyspareunia」の詳細全文を読む スポンサード リンク
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